Freedom from Pharmaceutical Addiction, Fibromyalgia & PTSD

Research

Restless sleep makes you really pissed off for the want of better words.

Im’ so tired…

I struggled to make a cup of coffee this morning and dropped my cup on the floor, it smashed to bits, then in a frivolous fury of frustration; I grabbed the coffee jar and slammed it into the floor, the glass shattered in all directions and the brown coffee granules ejected all over the room.

What a mess!

10:38

Shell has been off with me for days, I am really feeling the pressure of trying to be nice on the outside when you’re dying from within.

Maybe there is hope after all, Shell just sent me a text and usually I keep those things private but there are exceptions to the rule right?

She said:

I love you so very much, I feel your pain but don’t know how to take it away or how to comfort you.

I feel you are slipping away from me more each day and that scares me.

I try to hold you, Tell you I love you, I must find another way to bring you back to me.

That bond between us was like a rope that keeps pulling us back together, the rope has worn thin and frayed.

I must strengthen the rope and not let it break like string.

I know you feel our love is held together by cobwebs, but know that cobweb is one of the strongest materials known to us, if we keep puling on the rope together in the same direction we will be able to get closer to each other and tie a knot, rather than tormenting each other in a bitter tug of war.

11:47

I got a very special message from a very special person, no names sorry! They know who they are.

It said: (slightly modified for privacy)

I don’t blame you, I did not mind as I still read everything everyday , it seems like your depression is getting worse and I don’t want that for you. I know what Shell did was wrong and I can only imagine what you are feeling but look how far you have come over the past 16 years, you CAN get through this.

You both need to enjoy each other no matter how much it hurts at the moment.

I know you love Shell very much and I know she does make mistakes, trust me I’ve been through some of them with her too; I have to keep saying, think about the kids! Because it rubs off on them especially at the age they are at, I don’t want them to feel down too.

By what I’ve been told about Shells dates speaking to her, it sounds to me that the baby is defiantly yours, so forget about everything else and shut the world out, you and Shell have a baby on the way and your little family is all that matters now.

Go and hug her even if it hurts you and tell her you love her give her, a little positive note and say that you know that you can get through it.

Then I want you to go and hug the kids and tell them you love them and that your sorry for being down lately and that your going to change that.

You may not think it at the moment but they need you now more than ever trust me.
I don’t know what I would do without my Dad.

Please just think to the future and not what has happened in the past, remember you can’t change that.

I love you Xxx

I hope you don’t mind me posting that message although modified ever so slightly as you know.

I love you to and thank you for caring and passing me a hand via words that I see with my eyes and feel in my heart.

I will do exactly as you suggest, today more than any other due to the tension it would make the biggest difference and liven up every bodies day, you really are a wonderful person and I am truly grateful and blessed to be apart of your life.

Thank you again for telling me just what I needed to hear, in such a sweet way.

It’s still early enough to finish the day off nicely.

As I finish this sentence the Sun has just yawned out loudly and appears in the garden gently erasing the rain clouds.

20:40

Although I am in a huge amount of pain and lethargy reminds me so, we have had a reasonable day today, it didn’t start to good with my mouth ranting despicable torment for a short while after the coffee incident. Since then we have started to get close again, closer than we have been for some days. I’m pleased for Shells message, a simple use of words to let me know she is hanging on to our relationship, I to will not let it go, I love you far too much to let it hang out to dry.

I guess this is apart of the process of healing from such pain.

22:43

I listen to Red Sky at Night from the album On An Island by David Gilmour and write how I feel.

Why is it every time I go out of my way to be divinely nice, treat Shell with the utmost respect that she deserves, make her happy by going out of my way to really love her, I screw it all up with my mouth?

Phew!

I love you sweetheart, saying that now after what I just said to you makes the words feel dry.

I wish my mouth would just STFU and stay with the loving kindness, I truly feel in my heart and mind.

Why do I seem to have this primal urge to just rant at you randomly in a fit of rage and venom?

Please understand that what I say is a result of the bad images in my mind I do not mean any of it especially about the baby not being mine, what a horrible person I am, how dare I make you feel like that, especially when pregnant.

I want to rip my head off and hammer it to my arse as just as things got better I let rip at Shell making her whimper in tears.

I’m sorry for acting childish and immature, and saying all that rubbish to you and the fact the kids heard my outrage saddens me deeply.

Bad person I feel, Bad person I am, mistakes I have not learned from, but I am just a man.

I love you Shell with every part of my soul, life with you is my destiny, if only I would realise it.

I burned the rope you tossed me before I even had a chance to catch it this evening, please I’m begging you, throw me another one, I promise not to ever let it go.

It was me that caused the resentment and hate tonight not you, you have tried so hard and I thank you with all of my being.

Please forgive me, my love, as now I really need to learn to forgive myself for ventures past and failed memories.

Like this:

I couldn’t sleep last night I kept waking up gasping for breath, every time Shell touches me lately I get a cold chill succumb me, her icy touch has frozen my heart so numb that it no longer feels anything.

We had Chinese finally, well everyone else did, I was not really bothered about it and didn’t order anything, we tried to watch a film together but when Shells hand started to brush my leg I suddenly stood, went across the other side of the room to my computer and sat there in a solum confusion and stooped.

Due to the weather the last few days, I have been in agony, the pain in my legs today has made it extremely hard to move around, harder to use the bathroom as it’s up stairs.

I have been getting rather severe cramps in my legs lasting twenty minutes or so, these cramps come and go randomly, I have toppled over several times today.

Shell and I still are not talking, this has gone beyond a joke now, not only do I feel alone, even in my own house I sit alone in the dark.

Suffering with chronic fatigue today and can’t sleep, I am extremely run down and depressed.
I really can’t be bothered with anything much today, Shell has reduced me to a pittance of a Human wallowing in shallow pits of vile poisons.

Like this:

Got up early again, I still can’t get to sleep at night till some o’clock in the a.m, yet I awake before the kids most mornings, if not only three of four hours after I slept, I’m so tired this week, in fact this month.

Around lunch time, Shell and I had a tiff, pointless argument, she is annoying me a lot lately.

She won’t talk to me, won’t write to me, she will have sex with me, I guess that is all I am worth.

The last day or so I do not really have any desire to get that close to her, just leave me alone to wallow in self pity.

Spent a few hours mixing lyrics I am starting to get the hang of this now, it is a shame my vocals sound like a bunch of drowning cats.

The kids came down and joined in with the mix we had some fun for little while making funny voices.

Shell slept most of the morning on the sofa, the more I write and beg for her to connect with me the further apart she lefts us drift.

14:57

I had a bath, hot water, thank you, it’s a shame that our water bill as we are on a meter is £1500 in debt, what can I do?

Without hot water I suffer, with it I can live a semi normal day, I wish I could transfer my pharmaceuticals bill I am not consuming anymore to pay for the energy and water.

17:24

Wrote an Easter Poem and watched some video.
Realised it was 2 hours long so posted to watch later 😉

18:05

Chinese, what a great idea, we all sat around chose what we wanted, isn’t great/

18:40

Chinese was shut!, fiddle sticks.

19:00

Looked up passion and my evening went tits up from there and I spent the night alone being ignored again, mainly due to me crying so much, I guess Shell is tired of it, and went to bed leaving me solo.

Believe me when I say I am tired of crying, hating, hurting, resenting and every other ing!
It hurts so much my skin stings like my entire body had been sandblasted, peeled then slowly dipped in salt.

Listened to Emeli Sandé shouldn’t have done that, very bad idea, I upset myself some more.

20:52

Had another bath and listened to some Solfeggio Harmonics, this was extremely calming.
After only about ten minutes or so of listening I found myself feeling much more at ease, relaxed and comfortable.

Like this:

I am really getting behind with my progress but today is back on track XD.

Got up quite late today at around lunchtime, Shell had a private first appointment with a midwife as the topics to be discussed where not things I wanted to hear due to the affair, on a positive note everything is going well thus far although the literature and information Shell came home with from the midwife scared the life out of me.

Apparently due to her age she has a higher chance 1 in 105 of down syndrome and very soon we will be able to scan the baby to make sure everything is okay.

I have had a lots of bad images in my mind today of Shell and Darren, I am reframing them all and they are not hurting anywhere near as much, especially after our conversation we had recently about how used and abused she feels about the way he treated her.

She has not opened up to me before about this and I am pleased that she has, I know it is painful for me to hear her explain how he made her feel, she said that she felt disappointed she thought he was her friend, she felt disgusted, abused and that he is not the person she thought he was, but a person who’s only concerns where his own self pleasure and jealously of what we have.

In a way I wish I had never asked, but Shell has been more peaceful today I think that she really needed to let go of her hate for Darren as he clearly hurt her as well as everyone else purely due to his own selfishness.

Due to the nature of things she has had to have STI, and full blood work tests, results to follow!

I love you Shell with all my heart and soul and thank you for yesterday as we had a perfect day of loving kindness with the family and I look forward to many more of them in the future.

14:30

Shell has left to go back to the doctors as the midwife suggested she have a quick check-up.

16:37

I have just had a turbo and wow that feels good, Shell has been looking after me today as I am feeling low and due to the dank weather my body aches.

I just looked out of the window and noticed the sun rise above the clouds, fantastic I am going to sit in the garden in a while and just relax and be at one with nature.

Shell just got back, I keep bursting into tears today, I am not saying anything hurtful and am keeping the vengeance inside of my mind as after such a perfect day yesterday I do not want to spoil it.

Like this:

Reference tool responsible in death toll from prescription painkillers

SALT LAKE CITY — A standard reference tool used by the medical profession is so inaccurate that doctors across the country are accidentally killing patients by the thousands each year, according to an expert in Utah who co-authored a disturbing new study.

The study found that the faulty reference tool is responsible for a significant portion of the growing death toll from prescription painkillers.

“I think it could be thousands, nationally, for sure,” said Dr. Lynn Webster of Lifetree Clinical Research in Salt Lake City. He believes dozens of Utahns die each year for the same reason.

At issue are so-called “equianalgesic conversion tables.” Physicians use the tables to calculate the proper dose when a patient is switching from one “opioid” painkiller to another. The tables display equivalent doses of various drugs.

Webster and Dr. Perry G. Fine of the University of Utah co-authored the new study, which is a review of medical literature and forensic reports from around the country. It’s published in the April edition of Pain Medicine, the official journal of the American Academy of Pain Medicine.

The study may cause a stir because of the prominence of the two researchers. Fine is immediate past-president of AAPM and Webster is the organization’s president-elect.

“We’ve been taught that these equal analgesic tables are reasonably safe, as a guide,” Webster said. “And they’re not.”

Patients who need pain medication frequently switch from one drug to another. Doctors often prescribe a change because of side-effects such as nausea. Patients also switch drugs because they develop a tolerance for a given painkiller or because insurance companies won’t continue covering an expensive drug.

The prescribing physician typically figures out the proper equivalent dose by consulting the published conversion tables.

They’re often flat wrong, according to Webster.

“And that’s why we’re basically on a campaign nationally to make sure that every physician who prescribes an opioid understands they can’t use these conversion tables,” he said.

Nationally, an estimated 15,000 people die each year from overdoses of opioid pain medicine. That includes such familiar painkillers as Oxycontin, oxycodone, Percocet, morphine, and methadone.

“A lot of the deaths have been attributed to using these conversion tables and starting patients on too high of a dose,” Webster said.

“Methadone is the riskiest,” he said, but all the opioids can be deadly if the prescribing physician gets the dosage wrong.

He emphasizes that it’s not just drug addicts and long-term patients who are at risk.

“It could be somebody who’s been on pain medication after a hip operation or a knee operation for several weeks and it’s not working any more,” Webster said. When a physician uses the conversion tables to estimate the proper dose, “It could be very far off from what’s safe.”

As a solution to the problem, Webster recommends that a prescribing physician gradually phase in the new drug instead of abruptly switching from one to the other. He said the original dose should be reduced by 10 to 30 percent while the new drug is used at the lowest available dose. Then the original drug should be reduced by 10 to 25 percent each week while the new drug dosage is gradually increased.

Webster says physicians share the blame for the situation with the U.S. Food and Drug Administration and pharmaceutical manufacturers which encourage doctors to use the conversion tables.

“We came up with these estimates about how to determine what would be safe,” Webster said, “but they’re really not scientifically based.”

I can honestly say that I have nearly died twice just in the last year from overdoses that where prescribed to me by a doctor visiting my home.
A simple overdose of medication took me to the hospital as I hadn’t slept for four days solid and had a constant migraine throughout, upon arriving at the hospital they said if I had slept I would have probably died.

On the other occasion a visiting doctor gave me some neurotriptaline, sorry for the spelling.
I again ended up in accident and emergency this time with serotonine syndrome a deadly near death experience was had that day.

There must be tens of thousands of people dying each year from pharmaceuticals.

Abstract

Fibromyalgia is characterized by chronic widespread pain, clinical symptoms that include cognitive and sleep disturbances, and other abnormalities such as increased sensitivity to painful stimuli, increased sensitivity to multiple sensory modalities, and altered pain modulatory mechanisms. Here we relate experimental findings of fibromyalgia symptoms to anatomical and functional brain changes. Neuroimaging studies show augmented sensory processing in pain-related areas, which, together with gray matter decreases and neurochemical abnormalities in areas related to pain modulation, supports the psychophysical evidence of altered pain perception and inhibition. Gray matter decreases in areas related to emotional decision making and working memory suggest that cognitive disturbances could be related to brain alterations. Altered levels of neurotransmitters involved in sleep regulation link disordered sleep to neurochemical abnormalities. Thus, current evidence supports the view that at least some fibromyalgia symptoms are associated with brain dysfunctions or alterations, giving the long-held “it is all in your head” view of the disorder a new meaning.

1. Introduction

In order to examine the neurobiology underlying the symptoms of fibromyalgia, we must first determine what those symptoms are. Until recently, fibromyalgia (FM) was diagnosed based on the ARC1990 criteria [1], which were widespread pain in combination with tenderness at 11 or more of 18 specific tender point sites. The provisional ACR 2010 FM diagnostic criteria [2], suggested as an alternative method of diagnosing FM, do not require the presence of tenderness, but rather include a list of several other symptoms, including fatigue, unrefreshing sleep, and cognitive symptoms, as well as a mix of some other symptoms that could include headache, depression, and lower abdominal pain/cramping. The hallmark symptom is still widespread pain, and a diagnosis of fibromyalgia requires this symptom. However, a patient must also have some of the other symptoms that are common among FM patients in order to reach a composite score that would lead to a diagnosis of FM. In addition to clinical symptoms that make up the diagnosis of FM, experimental studies have identified a number of other abnormalities in FM patients, including increased sensitivity to multiple types of painful stimuli, increased sensitivity to other sensory modalities, and alterations in pain modulatory mechanisms. Further, neuroimaging studies have found functional, anatomical, and neurochemical differences in the brains of FM patients compared to healthy control subjects. Most of the clinical symptoms associated with FM have not been systematically studied in the experimental setting, but there are a number of studies that have provided an objective evaluation of the altered cognitive functioning and sleep disturbances reported in FM patients. Thus, this paper will focus on the experimental evidence related to FM symptoms and connect these perceptual and cognitive signs to abnormalities observed in the brains of FM patients.

The hallmark symptom of FM is widespread ongoing musculoskeletal pain. In addition, FM patients have been distinguished from other patients with widespread pain syndromes primarily by the presence of tenderness that has been assessed clinically by finding pain evoked by 4 kg manual pressure in at least 11 of 18 defined tender points. This tender point concept was not based on an understanding of the underlying pathophysiology, but rather on empirical observation. Thus, although the ARC-90 diagnostic criteria provided an important uniform tool for defining the FM syndrome, they did not validate the tender point concept, due to the circular evidence on which the criteria were based [3]. In fact, much evidence indicates that tender points are just sites normally more sensitive to pressure pain in all individuals [4–7] and that FM patients have an increased pressure sensitivity at non-tender-point sites as well [8]. Accumulating evidence now shows that FM patients have increased sensitivity to many types of painful stimulation, including pressure at non-tender-point sites [9], heat and cold pain [6,10–14], electrical stimulation [6], and intramuscular hypertonic saline injection [15]. Despite the plethora of evidence for hypersensitivity to painful stimuli, there is less evidence that FM patients are more sensitive to innocuous somatosensory stimuli. Detection thresholds for tactile and electrical stimuli are not altered in FM [6, 12, 13], but Hollins et al. [16] found that FM patients rated innocuous pressure as more intense than did healthy controls, although the effects in the innocuous range were weaker than in the noxious range. The evidence for changes in cool or warm detection also is mixed, with most investigators finding no differences between FM and controls for heat [6, 10] or cold [10, 12], whereas one study found FM patients to have reduced heat detection thresholds [12], and one study found patients to have reduced cold detection thresholds [6]. Thus, it appears that the altered sensitivity within the somatosensory system is more profound in the noxious range than in the innocuous range.

1.2. Evidence for Generalized Hypersensitivity to Unpleasant Stimuli

The hypersensitivity of FM patients to painful stimuli has led some investigators to propose that fibromyalgia involves a hypervigilance to pain and pain-associated information [17–19]. However, there is now evidence that the hypersensitivity to unpleasant stimuli extends beyond the somatosensory system, which has led to the hypothesis that there is a generalized hypervigilance for sensory stimuli in FM [16, 20, 21]. A few studies have examined the sensitivity of FM patients in modalities other than pain and found perceptual amplification. FM patients have been shown to have decreased tolerance of unpleasant noise [20] and increased sensitivity to loud unpleasant auditory stimuli that parallels their increased pressure pain sensitivity [22]. Similarly, FM patients perceive unpleasant olfactory stimuli to be more intense and more unpleasant than do matched control subjects [23]. On the other hand, when pleasant odors were tested, FM patients and controls perceived the odors as equally intense, consistent with another evidence that the hypersensitivity across perceptual modalities may be confined to stimuli in the unpleasant range [24]. Nevertheless, for pleasant odors, although FM patients did not rate them as more intense, they did evaluate the pleasant odors as less pleasant than did control subjects. Further, a range of auditory stimuli were rated as more intense by FM patients than by controls, and auditory stimuli rated as mildly pleasant by healthy subjects were rated as somewhat unpleasant by FM patients [16]. The finding of hypersensitivity in multiple modalities of stimulation, particularly for unpleasant stimuli, suggests that the evoked pain sensitivity of FM may be related to an altered hedonic appreciation for sensory stimuli, rather than to peripheral tissue abnormalities.

1.3. Other Phenomena Related to Altered Pain Perception

Other types of evidence from experimental pain studies in FM patients support the idea of a centrally mediated up-regulation of nociceptive activity in the CNS. A central pathophysiological process that appears to be disturbed in FM patients is the “windup” of central nociceptive processing of C-fibre input to the spinal cord, resulting in the perceptual phenomenon of temporal summation of pain. Windup of nociceptive activity is dependent on activation of the NMDA receptor complex in the spinal cord by input from C-nociceptors [25, 26]. Some FM patients show increased temporal summation of pain and increased aftersensations at the termination of noxious stimulation [27]. These enhanced responses could be related to one or more of several possible factors: (1) an ongoing peripheral source of input from C nociceptors other than the applied stimulus; (2) sensitized NMDA receptors on central nociceptive neurons; (3) abnormalities in descending modulation; (4) abnormal processing at supraspinal levels. Evidence of increased sensitivity in multiple sensory modalities suggests that ongoing C-nociceptor input cannot alone account for FM symptoms, indicating that there probably also are either sensitized NMDA receptors, abnormalities in modulatory systems in the brain, or abnormal sensory processing at spinal or supraspinal levels. Increased sensitivity has been demonstrated at the spinal level in FM [11]. Staud et al. [28] showed that an NMDA inhibitor reduced temporal summation in both healthy people and FM patients, suggesting that NMDA receptors probably are not sensitized in FM. On the other hand, experimental evidence shows that there are abnormalities in pain modulatory systems in FM patients that could account for altered temporal summation and other putative spinal effects.

1.4. Altered Pain Inhibition in FM Patients

For hundreds of years, clinicians have known that pain inhibits pain, a phenomenon termed “counterirritation.” More recently, a physiological basis of this phenomenon has been identified; the application of noxious stimulation activates an endogenous analgesic system involving supraspinal descending control of dorsal horn nociceptive activity. This system is termed “diffuse noxious inhibitory control” or DNIC and its physiological basis in the spinal cord has been studied extensively in anesthetized animals [29, 30]. Nevertheless, when competing noxious stimuli are presented in conscious humans, other systems that modulate pain, such as distraction, also are probably in effect, so that care must be taken in inferring that perceptual effects are due to DNIC. Accordingly, a group of interested researchers has suggested that the term “conditioned pain modulation” be used in humans studies to avoid the mechanistic implication [31]. Studies that have examined conditioned pain modulation in FM patients show that conditioning stimuli that produce an analgesic response to experimental pain stimuli in healthy control subjects fail to have an effect on FM patients [13, 32–34]. One of these studies controlled for the effects of distraction and habituation and found a similar lack of conditioned pain modulation in FM patients [33], suggesting the possibility that the DNIC system is in fact impaired in these individuals. Alternatively, DNIC and other descending inhibitory systems could be activated by the widespread pain of FM, and the failure to demonstrate DNIC in FM could represent a ceiling effect in which these activated systems cannot be further engaged by the experimental manipulations [8]. In addition, distraction can have a powerful pain-inhibiting effect [35–39], and some researchers have suggested that FM patients have altered attentional focusing, with a hypervigilance to unpleasant stimuli (see discussion above).

2. Other Symptoms of FM

2.1. Altered Cognitive Function in FM Patients

In addition to pain, many patients with fibromyalgia complain of problems with memory and concentration, often referred to as “fibrofog” [40–43]. This clinical symptom has received a large amount of experimental study, and studies using objective cognitive tests substantiate patients’ subjective reports of cognitive dysfunctions, most commonly related to speed of information processing, attention, and memory [43–56]. The most robust deficits in tests of memory and attention have so far been observed in paradigms involving a prominent distraction from a competing source of information, wherein FM patients are less capable than healthy controls to retain new information when rehearsal is prevented by a distraction [49, 50, 57]. Milder deficits have been observed in memory free of distraction at encoding [43, 44, 48, 49, 51, 58, 59]. FM patients frequently display greater impairments in the ability to actively retrieve past episodic events in the absence of a cue (free recall) than on recognition tests, which serve to evaluate the retrieval of remembered information and are more resistant to the effects of impaired attention and concentration [43, 44, 48, 51]. It has thus been proposed that memory impairments in FM are more highly related to attentional factors that modulate the efficiency of memory functioning than to primary memory processes per se [48, 60, 61]. Thus, the inability to manage distraction seems to be a particular problem in fibromyalgia patients and is reflected in patients’ reports of difficulty concentrating and dealing with complex, rapidly changing environments [61] and by memory tests showing performance decrements in the presence of distraction. Impaired cognitive performance is evident even after controlling for anxiety and depression and the influence of medications that might affect cognitive functioning [43, 50, 52, 58]. Another area of cognitive functioning that has been shown to be abnormal in FM is that of emotional decision making [62, 63]. A similar deficit has been shown in chronic back pain patients, suggesting that this is not unique to FM [64].

2.2. Sleep Disturbances in FM Patients

Many FM patients complain of unrefreshed sleep. Several laboratory studies using objective measures of sleep physiology such as EEG substantiate these reports by showing disordered sleep architecture in FM patients, including delayed onset to sleep, altered sleep stage dynamics, and reduced slow wave sleep (deep sleep) and rapid-eye movement (REM) sleep [65–68]. The intrusion of EEG frequencies characteristic of wakefulness (alpha waves) in the deep non-REM sleep (delta waves) seems to be a prominent feature of the nonrestorative sleep of FM patients [65, 69–71]. Further, patients with FM often have fragmented sleep resulting from periodic intrusions such as involuntary limb movements (restless legs), sleep apnea, and arousal disturbances [68, 72–74]. Although FM patients tend to report greater disturbances in sleep duration and quality than shown in laboratory studies, and their subjective reports correlate better with the severity of clinical symptoms [75], objectively measured sleep disturbances have been associated with pain and subjective daily sleepiness in several studies [67, 68,71, 73].

3. Brain Changes That Could Underlie Symptoms

3.1. Neural Basis of Pain Amplification and Altered Pain Modulation

Functional brain imaging studies support psychophysical findings of increased pain perception in FM, in that there is an augmentation of sensory processing throughout pain-related brain regions [9, 76–81]. This is important, since laboratory findings of increased sensitivity could be interpreted as a reporting bias, rather than evidence of increased activation in pain pathways. The functional imaging studies have found that fibromyalgia patients show significantly more activity in response to pressure and thermal stimuli compared to controls in a number of brain regions. Increased activations were observed not only in limbic structures, but also in brain regions involved in sensory-discriminative processing, such as primary and secondary somatosensory cortices, which supports the view that neural responses to afferent signals are amplified in fibromyalgia.

Although the increased pain-evoked brain activations corroborate patients’ reports, the correlation between increased brain activity and increased pain perception does not explain how the afferent signal is amplified. As discussed above, there is psychophysical evidence of dysfunctions in pain modulation as well as pain perception. There is now much evidence that the activation of descending control circuitry is involved in pain modulation and that this circuitry includes parts of prefrontal, cingulate, and insular cortices [23, 36, 37, 82, 83]. A number of anatomical imaging studies in FM patients reveal decreased brain gray matter in these regions [84–90]. Although the cellular basis of decreased gray matter in FM patients is not known, it is possible that due to neuronal loss, decreased dendritic arborisation, or changes in glial activation, pain inhibitory systems do not work in FM patients as well as in healthy individuals.

Consistent with the idea that pain modulatory systems may be disturbed in fibromyalgia are data showing that some FM patients have abnormalities in neurochemical systems involved in pain control, including the forebrain opioid and dopamine systems. A positron emission tomography (PET) competitive binding study using the D2/D3 receptor antagonist [11C] raclopride showed that striatal dopamine is released in response to painful muscle stimulation in healthy subjects, but not in FM patients [15, 91], which might partially explain the increased sensitivity of FM patients to the painful muscle stimulation. For the opioid system, investigators using PET found that FM patients had decreased binding potentials at rest for the exogenously administered 𝜇-opioid receptor agonist carfentanil in several brain areas, including the ventral striatum, the anterior cingulate cortex, and the amygdala [92]. These areas are implicated in pain and its emotional modulation, and correspondingly, the binding potentials showed a negative relationship with the magnitude of affective pain scores relative to the sensory scores. Although results of this study do not tell us whether levels of endogenous opioids were increased or whether receptor availability was decreased, the findings support the notion that disturbances in the opioidergic system might be related to the increased pain sensitivity in fibromyalgia. For both dopamine and opioids, the ongoing widespread pain of FM could lead to a tonic activation within these systems and thus be a main factor in altering receptor availability and associated responsiveness to externally applied painful stimuli.

3.2. Neural Basis of Cognitive Symptoms

It is well known that cognitive capabilities such as attention and memory functions decline continuously across the adult lifespan [93], which, together with findings of accelerated age-related decline of brain gray matter observed in FM patients [84], suggests that there may be a relationship between gray matter reductions in FM and cognitive deficits in these patients. Two recent studies have linked FM to impaired emotional decision making [62, 63]. Anatomical imaging studies have reported that FM patients have decreased gray matter in the medial prefrontal and insular cortices [84, 85, 89], areas implicated in emotional decision making [94–99]. Together, these data suggest a possible association between gray matter loss and emotional decision making in FM. One study has directly examined the relationship between performance on working memory tasks and gray matter in FM patients and found that an individual’s performance was positively correlated with gray matter values in medial frontal and anterior cingulate cortices, thereby providing direct evidence for an association between altered working memory and gray matter morphology in fibromyalgia [51]. Both of these brain regions, together with lateral premotor cortex, lateral prefrontal cortex, frontal poles, and posterior parietal cortex, are areas known to be related to working memory processes [100–105]. In terms of the neurochemical abnormalities in FM discussed above, dopamine plays an important role for cognitive functioning. Multiple lines of evidence demonstrate the importance of mesocortical and striatal dopaminergic pathways in memory tasks, perceptual speed, and response inhibition (see [106] for review). Thus, there is an overlap between tasks in which fibromyalgia patients perform poorly and tasks that are related to dopamine functioning, suggesting that a dysfunctional dopamine system could contribute to the cognitive symptoms of fibromyalgia.

3.3. Neural Basis of Sleep Disturbances

While many studies have used EEG and related methods to show various aspects of disordered sleep physiology in FM patients, little is known about the neurobiology underlying these disturbances. Several neurotransmitters have been proposed to influence CNS hypersensitivity associated with sleep alterations. For example, inhibition of the CNS serotonin synthesis has been linked to insomnia and increased pain sensitivity [107]. Accordingly, in FM there is evidence for low serum and cerebrospinal fluid serotonin levels [108, 109]. Injecting amounts of substance P into the CNS of rats has been shown to reduce sleep efficiency, increasing latency to onset to sleep and provoking awakenings from sleep [110], and there is evidence for elevated cerebrospinal fluid levels of substance P in FM patients [111,112].

3.4. What Do the Psychophysical, Cognitive, and Neuroimaging Studies Tell Us about the Neurobiology Underlying FM Symptoms?

The wealth of experimental evidence showing that FM patients are hypersensitive to painful stimuli, as well as unpleasant stimuli from other sensory modalities, in conjunction with functional brain imaging data showing increased stimulus-evoked activation throughout nociceptive pathways, shows that the defining symptom of FM—increased pain—is in fact real and not just a response bias of the patients. The finding that perception is increased in multiple modalities speaks against the hypothesis that FM pain is due to an upregulation of peripheral nociceptive processes. Further, psychophysical evidence that descending modulatory systems are altered in FM patients supports the opposing idea that FM symptoms are at least in part caused by alterations in CNS processing of the pain signal, including a dysregulation of pain modulatory systems. Nevertheless, the apparent dysregulation within these systems could be caused and/or perpetuated by a tonic activation related to the presence of ongoing widespread pain, so that the systems are saturated and cannot regulate further in response to external stimuli.

Since similar descending control systems, including attentional and emotional regulatory circuitry, affect multiple sensory modalities [113–119], a dysfunction (or saturation) in these systems could lead to the hypersensitivity in multiple sensory modalities. FM patients show reduced habituation to nonpainful tactile stimuli and increased cortical response to intense auditory stimuli, both of which have been linked to deficient inhibition of incoming sensory stimuli [120, 121]. Also in support of the idea of a central dysregulation or saturation of pain modulation are changes in the opioid and dopamine neurotransmitter systems, both known to be involved in hedonic regulation [122].

Finally, the findings that FM patients not only perceive themselves to have altered memory and concentration (“fibrofog”), but also in fact perform poorly on multiple cognitive tests, even when depression is excluded as a contributing factor, suggest that there are alterations in brain function. The anatomical brain imaging studies that show reductions in gray matter in frontal regions important for cognitive function further indicate that this common symptom of FM is based on altered brain function. Together, the experimental evidence provides strong support for the idea that FM symptoms are related to dysfunctions in the central nervous system. The cause of these changes cannot be deduced from the available evidence, as it is correlational in nature. Did long-term ongoing pain cause the changes or did the changes cause the pain? Without a relevant animal model or long-term longitudinal studies, we cannot answer these questions. Nevertheless, we can at least say that fibromyalgia is real and that it is associated with multiple changes in the brain.

A. S. Champod and M. Petrides, “Dissociable roles of the posterior parietal and the prefrontal cortex in manipulation and monitoring processes,” Proceedings of the National Academy of Sciences of the United States of America, vol. 104, no. 37, pp. 14837–14842, 2007. View at Publisher · View at Google Scholar · View at PubMed

Resentment is often at the heart of conflict. It’s the kind of anger that says, “I don’t deserve this” and “you are wrong.” So it’s not just an emotion; it makes claims about how you think you deserve to be treated, and that someone has not complied with that expectation.

09:30

I was rudely awoken really early this morning by the telephone ringing, it had rung to the point of frustration, to that point where you knew that if you had only got up to answer it; it would have stopped already!

Shell and the kids had left for school it was about 8:30 am the first time it called, it then rang over and over till about 09:30 am, I got up, hobbled down the stairs and answered it to a dial tone.

It rang shortly afterwards it was Shell’s friend whom is undergoing a difficult break up, she wanted to speak with her urgently!

She asked me if she had woken me up, I grumpily replied YES, told her to call her mobile and promptly hung up.

I must admit I do care for Shell’s friend dearly but her relationship problems are causing background stress and problems with ours, this is mainly due to the worry it causes Shell and her friends stress rubs of onto her making Shell stressed out. She has been calling at really inconvenient times, not her fault I know, often in the middle of dinner, a family film, and more frequently interrupting us talking when the kids are asleep.

I couldn’t sleep last night, no nightmares or bad images, but the pain in my spine kept me tossing and turning in anguish, thwarting my rest, I remember looking at the clock on my phone, I keep it under my pillow; it said 04:53 am.

Having only a few hours sleep is not good for a FM sufferer, I am full of Fibro Fog today, my mind feels numb and cloudy and I am having a hard time concentrating on what the hell I am doing, yet alone what I’m saying.

My back hurts and feels like it is twisted, buckled, crushed and trampled, my ankles cause severe discomfort when I put weight on them and I have pins and needles down the left side of my body, emotionally, I am completely drained, my batteries are not depleted they have been completely removed, Apple Menu / Shut Down.

10:26

Shell made an unscheduled trip to the doctors this morning as she had cramps in her belly, she is okay thankfully but my anxt has been increased as the doctor made the conception dates closer to the affair date.

For the first time since this happened almost six weeks ago, I threw everything in Shells face all at once, please forgive me my love, it pains me to see you cry.

I feel so terrible and bitter, how can I say I love her the way I do and still feel so much pain and resentment?

I know we can fix this, today I feel that it was me that broke a string on our bow of love and not the other way around.

Although it is not my fault what happened, I should not have been so mean and inconsiderate to your feelings today.

Afterwards you smiled at me and said lets start the day again and I am pleased that you think I am worth that, I thank you for being so strong, I am liking this new more positive and affirmative you it suits you beautifully.

Sigh, today I let my brain and my emotions get the better of me, there is no excuse for it what so ever!

Apologising after the fact when you have said some really unthoughtful and hurtful things seems pointless, how ever I did try really hard to explain to Shell how looking at the calendar and figuring out conception dates to date how far she is gone was extremely hard for me to deal with, I found out Shell had the affair on my daughters birthday I only just realised this fact to be the case and Darren had come down that weekend and both of them knew of the occasion.

In addition to this we have received contact from him twice in the last week, and from others chatting malicious chants of upsetting propaganda.

I know I acted harshly and said a lot things I really shouldn’t have, how does one control the tongue’s ravenous tone?

For the first time since this tragedy, I actually lost it, all down to pure resentment, and for that I am truly despondent!

I was not thinking about what I was saying, how much it hurt, or even who was listening, at one point I was crying and ranting to my self on my own in the front room in turmoil, in a tantrum of fear, I wandered around the room crying and dribbling on myself.

I guess there will be days like this and I am thankful that they have been very few and far between, I have counselling tonight with Relate and am going to ask them to concentrate on my emotional outbursts as it is these that are putting pressure on both us and our healing.

Shell’s Mum has been saying she is worried about me, she worries because she feels I am trying to hard, maybe I am but what more can I do?

I have to try harder, clearly as I am still having times where my emotional pain is passing on to others and tormenting them.

13:12

Shell made us both a Turbo and then went to pick up our son from School.

Apart from the turmoil this morning we have had a good day, the sun is shining once again and I am going to sit in it’s healing light and just be still.

I have learnt a very valuable lesson today, that we all must be responsible not only for our actions but also for our words.

15:54

Shell just sent me a text I know she won’t mind me publishing it’s contents.

Shell says:

I love you so very much, you are everything my heart desires, I thank you for staying with me and wish you happiness and joy.

I said:

Namaste my Queen, may the light of our love shine eternal.

17:00

My support worker from YOU has just left and I went through the events of the last month once again, it does not matter how many times I speak about what happened it hurts just the same, I wish I could simply erase it from my mind.

She has known Shell and I for about a year now and was surprised her self at what had happened, there wasn’t any thing really to say or to do except to arrange some things regarding our move and sort out some paperwork.

20:00

Appointment with Relate for my first counselling session!
I’ll write about how that went later, no doubt I will have to traumatise my self again explaining to the counsellor what’s up, but I know that this will help us heal.

21:49

Just got back from my appointment with Relate I had a cry and a chat about it with Shell for about forty five minutes, she is now relaxing in the bath so I have some time to share my first appointment experience.

Wow! that was tough.

I arrived for my first appointment to Relate (Relationship counselling) apprehensive and anxious, I booked in at reception and was greeted with a smile, I was asked to wait in a small waiting room off to the side, it was painted white, and was very clinical, it had half a dozen chairs, I hadn’t noticed at first and thought they was all red, except for the one I was sitting on as it was green in colour, trust me to pick the odd one ^^

Multiple informational brochures, advice leaflets and such adorned the walls, As my eyes met up with the paraphernalia I started to notice the subject lines of the said pamphlets.

Subjects such as Has your partner been unfaithful?Suffering from the effects of an Affair? etc…
It is a relationship counselling service, so of course one would expect them to have literature on such subjects, for me though each and every one of them popped out as though to taunt me, then I burst into tears.

It wasn’t long before the counsellor popped her head around the corner, assumed it was me as I was alone and we headed towards another room.

This is where the roller coaster of torment, emotions and hap hazard babbling began.
It is not that the counsellor made me feel uneasy or that I felt ashamed of being there but letting it all out made my chest hurt, and my breath became irate and obtrusive.

She calmly passed me a tissue from a nearby box and patiently awaited my conformity.
After I got myself together she began to ask me a series of questions some of which where extremely painful to think about not alone answer.

Because of my pharmaceutical addiction, previous violent behaviour, our relationship problems, death in the family and the fact we had been evicted from a home recently she suggested that to treat me for relationship counselling I must first or as well as have psychodynamic therapy, this requires me to see a GP and get refereed, hopefully my support worker can assist me in arranging this as I really want to make our relationship work but I must address my own mental health issues first and for most if we are to get anywhere.

Shell is going there the same time next week, hopefully she won’t be considered as mad as me so she can get immediate help, I on the other hand am going to have to wait a while on a waiting list of some months before getting any help at all.

Overall it was a tough experience but I did feel some form of peace as I left the building and headed home.
It was worth going, it was my first step, unfortunately for me the next time I get some counselling might be a while, and the counsellor did say I needed assistance to help myself and there is nothing wrong with that.

Like this:

The soul always knows what to do the heal itself. The challenge is to silence the mind

Often we find our selves battling our inner demons, the voices in our mind that torture us with their whining and pity.
Know that this is your voice, you are talking to your self, it is normal, it is okay, try changing those nasty voices in your mind to something more comical like mickey mouse or road runner, meep meep, I am sure if you think of a daft and silly voice to replace the idiots in your mind you to can see the funny side of the darker side of life.

A blog reaching out to victims of abuse and others in need, providing insight about abuse, hope for the future, and guidance to see THE LIGHT that lead Secret Angel out of the darkness of her own abusive situation and helped her to not only survive but to overcome.